Karla said people were too loud. Everyday voices and normal sounds suddenly felt overwhelming to her.
About 15 months ago, doctors put small ventilation tubes in her eardrums. After years of struggling to hear us, our youngest could finally hear well enough to complain.
She’s six now, but her hearing problems started when she was a toddler or even a baby.
She made noises, but the words we hoped for didn’t come. She didn’t say Mom or Dad. While other children started talking, we tried to figure out what was going on.
By age three or four, she had created her own way of speaking. We slowly figured out which sounds meant she was hungry or needed the bathroom. Our family understood her, but others did not.
Sometimes she tried to tell us something we just couldn’t understand. She would get upset, break down, and cry on the floor. I still remember those moments. Watching your child struggle to make you understand is heartbreaking.
We realized that some of her reactions meant she couldn’t hear us or didn’t understand. We kept talking to her, and she kept trying. Remembering this still hurts.
Karla had declined to participate
We’d seen ear specialists, but several exams didn’t give us any answers. Hearing tests were hard, partly because she was so young and partly because she’s Karla. She is a wild one, and she simply didn’t want to cooperate with the tests.
Eventually, we got her into an early-childhood assessment program in Berlin. The program included checks on her development and neurology. Another ear exam found fluid in both of her middle ears.
The medical name is otitis media with effusion, usually called glue ear. Fluid collects behind the eardrum without an acute ear infection and can interfere with sound passing through the middle ear. Those little tubes let air into that space [1,2].
I still don’t know why it took so long. She struggled for about three years, and those years felt endless to us. I can’t figure out what the earlier exams might have missed.
The doctor’s take: Persistent trouble with hearing or speech deserves an assessment that fits the child’s age and development [1]. A toddler’s refusal to cooperate leaves a question that still needs answering.
For those of us who spend much of our work listening to others, there’s an adult version of that same problem. You might get through a meeting but still struggle to follow what was said. In a senior job, you have to make decisions based on what you heard. At home, someone may need you to listen with more patience than you feel you have.
That’s why hearing should be part of any conversation about long-term performance. The effort it takes to listen can matter long before dementia is ever mentioned.
You got the words right
A standard hearing test checks how soft a sound you can hear at different pitches. But following someone speaking in background noise is much harder. Researchers call the mental work needed to overcome hearing problems listening effort [3].
In a 2025 study, Maggie Zink and colleagues compared adults aged 40–55 with adults aged 18–25. Everyone had normal results on standard hearing tests. In one moderately noisy condition, the middle-aged adults got the speech about as accurately as the younger ones, while changes in their pupils suggested greater effort after the sentences [4].
This was a small lab study, and the results depended on the test conditions and timing. They didn’t look at fatigue after a full workday. I would pay close attention to anyone who says they struggle in group conversations even if their hearing test is normal. NICE’s adult hearing guidelines also recognize that standard tests may not explain trouble hearing in noisy places [5].
If this sounds familiar, tell your hearing specialist exactly when and where you have trouble. It helps to explain whether it’s during a quiet talk, a group dinner, or a call with people talking at once [5].
In two lab experiments, Anastasios Sarampalis and his team tested young adults with normal hearing. Noise made it harder for them to remember words or respond to a visual task at the same time [6]. I think it’s important to consider the listening conditions before blaming every missed detail on memory problems.
We were adding English to this
Our two older children attend an international school. We speak German at home, but their friends, books, and Netflix choices make English a big part of their lives.
We enrolled Karla in the same kindergarten. She was already having trouble communicating, and now we were adding another language. We worried she might feel left out if she didn’t learn English like her siblings. We hoped she’d manage in either language, but we also wondered if we were making things harder for her.
The American Speech-Language-Hearing Association says that being multilingual doesn’t cause speech or language disorders [7]. Still, our decision about kindergarten left us with doubts. Parenting would be much easier if the research came with instructions for your own child.
Since the procedure, her speech has been catching up at a rate I still find astonishing. She practices a LOT, talking and asking questions until you can barely think straight.
A Cochrane review found that tubes can bring small improvements in hearing for children in the short and medium term, but it’s unclear if the benefits last [2]. Karla has also been getting speech therapy. Our experience may not be the same for every family.
The doctor’s take: I would look into ongoing listening problems in anyone who feels worn out by calls. I’d also check their workload and overall health. There are many things at work that an audiologist can’t solve.
It’s important to know what to treat. A five-year study of 587 working adults found that worse hearing in noisy places was linked to a small increase in the need to recover after work [8]. Another study showed that people who got their first hearing aids felt less listening-related fatigue than those who didn’t, but their overall tiredness didn’t always get better [9]. A workplace hearing program tested in 136 employees didn’t show much improvement in recovery needs compared to usual care over a year [10].
In my Upward ARC framework, hearing is part of Capacity. I want you to be able to follow the conversations at work and still have the patience for the ones at home.
The ears were a badge of honor
My own ears have a less emotional story. Wrestling damaged both of them, and now they’re different shapes.
In wrestling, deformed ears can signal that you’re a proper fighter. I was skeptical of this idea. It gives a sport that damages your ears a very convenient reason to celebrate the damage.
When it happened to my ears, I took extra care treating them. Now, my ears look normal unless you look closely. But regular earbuds always fell out. Whatever respect my ears earned in wrestling didn’t help when I just wanted to make a phone call.
Eventually, I spent a lot on custom earphones. I went to a hearing aid shop and had molds made of my ears. The finished earpieces looked like the monitors musicians use on stage, and each one fit its ear perfectly.
After that, I could hear small changes in people’s voices on the phone, even their breathing. With earphones that finally stayed in, listening on calls felt like a superpower.
These are high-end earphones, but they don’t amplify sound like hearing aids. I’m just sharing my excitement about the purchase, not making any health claims. If regular earbuds don’t stay in your ears either, I get why you’d spend extra for a custom pair.
You can also help improve the sound for everyone else. In interviews with 14 Swedish employees with hearing loss, clear audio, visible speakers, and taking turns made video meetings easier to follow. Some even found video meetings easier than meeting in person [11]. These are personal experiences, not measured productivity.
If you’re in a senior role, you can ask for better microphones and speakers, and encourage people not to talk over each other. Try using captions if they help, and ask anyone struggling what makes meetings easier for them [5,11].
For adults with mild to moderate hearing loss, a recent Cochrane review of 16 trials found that hearing aids probably help people listen and take part in daily life. Most participants were older adults [12]. A 2017 review found no clear drop in listening effort and rated the evidence as very low [13]. These are different results. At follow-up, I’d ask if the conversation that brought you in has become easier, and adjust the care plan based on what’s still hard [5].
What I’d promise someone worried about dementia
I wrote about dementia last August. If you’re concerned about your memory, hearing research gives you a reason to pay attention; and a number that’s easy to misinterpret.
ACHIEVE tested hearing care against health education in 977 adults aged 70–84 with untreated hearing loss. Across the full trial, hearing care did not slow decline in memory and thinking-test scores over three years [14].
The 48% result comes from a planned analysis of 238 participants recruited from a long-running heart study. Those who received hearing care declined 48% less on cognitive tests over three years than those who received health education. These recruits were older and had more risk factors than the other participants. Their health-education group also declined faster than the other trial controls [14].
That treatment difference was about one-fifth of a standard deviation, a measure of the spread in test scores. New cognitive impairment wasn’t significantly reduced, either overall or in the heart-study group. This outcome included diagnosed dementia, milder diagnosed thinking or memory problems, or a sustained drop in test scores [14].
A large Danish study found a link between hearing loss and later dementia [15]. But studies like this can miss differences in education or access to care. The ACHIEVE trial tested treatment, and its authors think that slower decline in healthier participants may have made it harder to see a benefit. Preventing dementia through hearing care in middle age is still unproven.
The doctor’s take: I’d address a hearing problem for the conversations it’s affecting today. The cognitive results add a reason to take it seriously as we age. I wouldn’t offer a 48% promise to someone sitting across from me.
Try this today
Write down one situation where you often have trouble following speech. Schedule a hearing test and share that example, including any problems you have at home [5].
On your next tough call, try changing one thing, like using a clearer microphone, turning on captions, or making sure people take turns. See if it helps you follow the conversation [5,11].
If you already use hearing aids, mention any ongoing problems at your follow-up. Sometimes the fit needs adjusting, and your care plan should focus on what you still need to hear [5].
Protect your hearing during loud activities by using proper ear protection and avoiding harmful noise. Distracting office noise and noise that can damage your hearing are two different issues [16].
If your hearing suddenly gets worse over three days or less, see a doctor within 24 hours [5].
First day of school
Karla still attends speech therapy, usually twice a week. Some words are hard for her, her sentences need improvement, and she’s still behind other kids her age.
Karla started school a week ago, with her preschool teachers fully recommending her for first grade. She was so proud, and I loved seeing her that way. A year and a half ago, I never would have imagined this.
I’m surprised it took me this long to write about her. For a long time, it felt too personal and too painful. Now, I think we’re far enough along to share our story, even though remembering her crying on the floor still hurts.
When do you find it hardest to follow a conversation? Reply and let me know. I read every message.
Stay healthy.
Andre
PS: If someone you know keeps struggling to follow calls or conversations, please forward this to them. This is how this newsletter grows, and it’s the only way I want it to.
PPS: If a friend sent you this, you can get Under Load, my Sunday edition, at
https://www.andreheeg.com
.
References
[1] National Institute for Health and Care Excellence. (2023, August 30). Otitis media with effusion in under 12s (NICE Guideline NG233). https://www.nice.org.uk/guidance/ng233/chapter/Recommendations
[2] MacKeith, S., Mulvaney, C. A., Galbraith, K., Webster, K. E., Connolly, R., Paing, A., Marom, T., Daniel, M., Venekamp, R. P., Rovers, M. M., & Schilder, A. G. M. (2023). Ventilation tubes (grommets) for otitis media with effusion (OME) in children. Cochrane Database of Systematic Reviews, 2023(11), Article CD015215. https://doi.org/10.1002/14651858.CD015215.pub2
[3] Pichora-Fuller, M. K., Kramer, S. E., Eckert, M. A., Edwards, B., Hornsby, B. W. Y., Humes, L. E., Lemke, U., Lunner, T., Matthen, M., Mackersie, C. L., Naylor, G., Phillips, N. A., Richter, M., Rudner, M., Sommers, M. S., Tremblay, K. L., & Wingfield, A. (2016). Hearing impairment and cognitive energy: The Framework for Understanding Effortful Listening (FUEL). Ear and Hearing, 37(Suppl. 1), 5S–27S. https://doi.org/10.1097/AUD.0000000000000312
[4] Zink, M. E., Zhen, L., McHaney, J. R., Klara, J., Yurasits, K., Cancel, V. E., Flemm, O., Mitchell, C., Datta, J., Chandresekaran, B., & Parthasarathy, A. (2025). Increased listening effort and cochlear neural degeneration underlie speech-in-noise deficits in normal-hearing middle-aged adults. eLife, 13, Article RP102823. https://doi.org/10.7554/eLife.102823
[5] National Institute for Health and Care Excellence. (2023, October 2). Hearing loss in adults: Assessment and management (NICE Guideline NG98). https://www.nice.org.uk/guidance/ng98/chapter/recommendations
[6] Sarampalis, A., Kalluri, S., Edwards, B., & Hafter, E. (2009). Objective measures of listening effort: Effects of background noise and noise reduction. Journal of Speech, Language, and Hearing Research, 52(5), 1230–1240. https://doi.org/10.1044/1092-4388(2009/08-0111)
[7] American Speech-Language-Hearing Association. (n.d.). Spoken language disorders [Practice Portal]. Retrieved September 11, 2026, from https://www.asha.org/practice-portal/clinical-topics/spoken-language-disorders/
[8] van Leeuwen, L. M., Goderie, T., van Wier, M. F., Lissenberg-Witte, B. I., Lemke, U., & Kramer, S. E. (2022). The longitudinal relationship between speech recognition in noise, need for recovery after work, job demand, and job control over a period of 5 years. Ear and Hearing, 43(2), 659–668. https://doi.org/10.1097/AUD.0000000000001127
[9] Holman, J. A., Drummond, A., & Naylor, G. (2021). Hearing aids reduce daily-life fatigue and increase social activity: A longitudinal study. Trends in Hearing, 25, Article 23312165211052786. https://doi.org/10.1177/23312165211052786
[10] Gussenhoven, A. H. M., Anema, J. R., Witte, B. I., Goverts, S. T., & Kramer, S. E. (2017). The effectiveness of a vocational enablement protocol for employees with hearing difficulties: Results of a randomized controlled trial. Trends in Hearing, 21, Article 2331216517692304. https://doi.org/10.1177/2331216517692304
[11] Marsja, E., Signoret, C., & Stenbäck, V. (2026). The digital workplace and meeting accessibility: A qualitative study on listening effort in video meetings for employees with hearing loss. WORK, 84(1), 197–209. https://doi.org/10.1177/10519815251398498
[12] Ferguson, M. A., Sarant, J. Z., Bennett, R. J., McIlhiney, P., Badcock, N., & Bothe, E. (2026). Hearing aids for mild to moderate hearing loss in adults. Cochrane Database of Systematic Reviews, 2026(8), Article CD012023. https://doi.org/10.1002/14651858.CD012023.pub3
[13] Ohlenforst, B., Zekveld, A. A., Jansma, E. P., Wang, Y., Naylor, G., Lorens, A., Lunner, T., & Kramer, S. E. (2017). Effects of hearing impairment and hearing aid amplification on listening effort: A systematic review. Ear and Hearing, 38(3), 267–281. https://doi.org/10.1097/AUD.0000000000000396
[14] Lin, F. R., Pike, J. R., Albert, M. S., Arnold, M., Burgard, S., Chisolm, T., Couper, D., Deal, J. A., Goman, A. M., Glynn, N. W., Gmelin, T., Gravens-Mueller, L., Hayden, K. M., Huang, A. R., Knopman, D., Mitchell, C. M., Mosley, T., Pankow, J. S., Reed, N. S., . . . ACHIEVE Collaborative Research Group. (2023). Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): A multicentre, randomised controlled trial. The Lancet, 402(10404), 786–797. https://doi.org/10.1016/S0140-6736(23)01406-X
[15] Cantuaria, M. L., Pedersen, E. R., Waldorff, F. B., Wermuth, L., Pedersen, K. M., Poulsen, A. H., Raaschou-Nielsen, O., Sørensen, M., & Schmidt, J. H. (2024). Hearing loss, hearing aid use, and risk of dementia in older adults. JAMA Otolaryngology–Head & Neck Surgery, 150(2), 157–164. https://doi.org/10.1001/jamaoto.2023.3509
[16] National Institute on Deafness and Other Communication Disorders. (2025, April 16). Noise-induced hearing loss. https://www.nidcd.nih.gov/health/noise-induced-hearing-loss